2/26/2024 0 Comments Eye synergy![]() $0 copay for 28 home-delivered meals immediately after an inpatient hospitalization or skilled nursing facility (SNF) stay. Meal Benefit $0 copay for 28 home-delivered meals immediately after an inpatient hospitalization or skilled nursing facility (SNF) stay. $0 copay 20 chiropractic visits per yearįoot Care - Routine 3 $0 copay 4 visits per year No Coverage $0 copay for Renew Active, which includes a free gym membership, plus online fitness classes, brain health challenges and 1 Fitbit® device.Īnnual Routine Physical 4 $0 copay 1 per year No CoverageĬhiropractic Care $0 copay 20 chiropractic visits per year No coverage $0 copay for Renew Active, which includes a free gym membership, plus online fitness classes, brain health challenges and 1 Fitbit® device. Plan pays up to $3,600 for hearing aids, up to 2 hearing aids every year through UnitedHealthcare Hearing.įitness Program through Renew Active® $0 copay for Renew Active, which includes a free gym membership, plus online fitness classes, brain health challenges and 1 Fitbit® device. Includes hearing aids delivered directly to you with virtual follow-up care (select models). ![]() Plan pays up to $3,600 for hearing aids, up to 2 hearing aids every year through UnitedHealthcare Hearing. Hearing Aids 3 Plan pays up to $3,600 for hearing aids, up to 2 hearing aids every year through UnitedHealthcare Hearing. Hearing Exam 3 $0 copay 1 per year No Coverage Home delivered eyewear available nationwide only through UnitedHealthcare Vision (select products only). Standard single, bifocal, trifocal, or progressive lenses are covered in full. ![]() Plan pays up to $450 every year for frames or contact lenses. $0 copay - $40 copay per visit ($0 copay when outside of the United States)Įye Exam 3 $0 copay 1 per year No Coverage Urgent Care $0 copay - $40 copay per visit ($0 copay when outside of the United States) $0 copay - $40 copay per visit ($0 copay when outside of the United States) Preventive Services (such as covered screenings, vaccinations, etc.) 2 $0 copay for covered services ![]() Preventive Services (such as covered screenings, vaccinations, etc.) Outpatient X-rays $0 copay - 20% of the cost Outpatient Hospital Services (includes observation services) 2 $0 copay - 20% of the cost Outpatient Hospital Services (includes observation services) Mental Health (outpatient) Group: $0 copay - 20% of the cost Inpatient Hospital Care $0 - $1,556 per stay $0 copay - 20% of the cost for ground or air $0 copay - $90 copay per visit ($0 copay when outside of the United States)Īmbulance Services $0 copay - 20% of the cost for ground or air $0 copay - 20% of the cost for ground or air Initial Coverage Stage - If you qualify for LIS (Extra Help)įor generic drugs (including drugs treated as generic):ĭuring the Coverage Gap Stage, the plan pays all of the cost of your drugs.ĭuring the Catastrophic Coverage Stage, the plan pays all of the cost for your drugsĪmbulatory Surgical Center 2 $0 copay - 20% of the costĭiabetes Monitoring Supplies 2 $0 copay for covered brandsĭiagnostic Radiology Services (such as MRIs/CT scans, etc.)ĭiagnostic Radiology Services (such as MRIs/CT scans, etc.) 0% of the cost - 20% of the costĭiagnostic Tests and Procedures, non-radiological (such as EKG/ECG tests, etc.)ĭiagnostic Tests and Procedures, non-radiological (such as EKG/ECG tests, etc.) $0 copay - 20% of the costĮmergency Care $0 copay - $90 copay per visit ($0 copay when outside of the United States) $0 copay - $90 copay per visit ($0 copay when outside of the United States) If your plan has an annual deductible, you (or others on your behalf) will pay your drug costs up to the amount of this deductible before moving into the Initial Coverage stage.
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